OK, I've been studying and have what may be an obvious question but since we're dealing with medicine and insurance - well, we all know they way things are done don't always make sense. Also, I could easily be mistaken in the facts as I understand them or be drawing faulty conclusions from them. I'd appreciate someone setting me straight.

Fact: Women with OSA are less likely to be diagnosed (for many reasons.)Fact: According to the studies I've read, women have the same health risks at a lower AHI then men do at a higher one.Fact: According to the studies I've read, women have more frequent, less severe respiratory events AND those events tend to be more concentrated in REM sleep.Fact: The longest period of REM sleep tends to be the last one, just before awakening for the day.Fact: Sleep studies average the number of qualifying events per hour of sleep to achieve AHI.Fact: During a split night sleep study, only the first half of the night is conducted under natural breathing then the second half is conducted with CPAP.

Question: During a woman's split night sleep study, how (if at all) is the AHI formula corrected for the facts that a- a woman can have the same health risks at a lower AHI as a man at a higher one and b- the greater concentration of respratory events would be expected to occur in the second half of the night for a woman?

My guess: She would go in for a sleep study. If the first half of the night does show OSA, then it is conducted as a split night sleep study and CPAP is added for the second half of the night. Since her OSA is probably most severe in the second half of the night, the correct settings can be determines during that time.If the first half of the night does NOT show enough events to warrant a diagnosis of OSA, the sleep study continues without CPAP for the entire night. If the number of later events raise the AHI to the threshold of waranting a diagnosis of OSA then a SECOND full night sleep study is scheduled to try her on CPAP.

I'm asking because sleep studies are expensive and I'd prefer to do it just once but I also fear being misdiagnosed. If the events contributing to my overall AHI are concentrated in the second half of sleep and I don't have enough of a problem in the first half of the night to be taken seriously, what happens?

I have recorded myself sleeping and noticed that I mostly have regular, rhythmic snoring most of the night, but the last 2 - 3 hours or so, I really sound like I'm struggling for air, choking, and snorting.

You know how your car makes a funny noise so you bring it to the shop and say, "What's this weird thing going on with my car?" and the car doesn't make that noise for the mechanic? And he says, "There's nothing wrong with you car. You're just paranoid".

Could that happen to me in a sleep study?

_________________I wake up every day and I think, 'I'm breathing! It's a good day.'

It can happen...it happened to me.My OSA is worse in REM. In non REM sleep not quite enough apnea events to meet my lab's criteria to end the first part of a split study and start cpap...missed it by 2 events.

Didn't meet criteria to be put on cpap during the first half of the sleep study and by the time I met criteria in the latter part of the night it was too late to have enough time to do a proper titration so I had to come back for the second sleep study.

So yeah, it can happen but we don't know that it will happen to you.No way to know ahead of time. We don't know how bad your OSA might be in non REM or even if it is markedly worse in REM or not.

My OSA was so severe they only let me sleep an hour and a half or so before waking me up to start titration. Unfortunately, it didn't go so well with regular CPAP, so they switched to bilevel the last the last hour or so I think, but between the lack of time and the fact that my throat was swollen from snoring all my life they wanted me to start on bilevel therapy with their best guess and come back a month or so later for another titration study. Their best guess was close, my pressure only dropped by 1cmH2O.

When your sleep tech is wiring you up for the night tell him/her your concerns. Find out what they do if this happens. Do they just let you sleep until it's time to get up, or do they wake you with only one or two hours left. If they say that they generally let you sleep, I would ask for them to wake you up and start at least fitting the masks on you and giving you some pressure to start with. This will give you a chance to have the experience and discover if there is something that you cannot tolerate about a type of mask. Ask for a chin strap if they do not offer one if you are a mouth breather, which you said you snore in the early parts of sleep so I'm thinking yes, and if you are wanting to try a nasal or nasal pillow mask. Chin straps aren't great, but can be better than nothing, but again, you are in it for the experience. If you can't stand it, you know you will need something else to keep your mouth closed for your next study if you still want to try a nasal/pillow mask. You'll want your second study to be as successful as possible and I was so much more comfortable with my second study, but I had been using my machine for 6 weeks and I had already switched from my FFM to a nasal cushion mask and switched from the chin strap to a bruxism type of mouth guard. At least if you have some experience with wearing a mask, even for only a couple of hours, that anxiety of the unknown will decrease.

Speaking of anxiety, are you claustrophobic? If so, I hope you have a coping mechanism in place. I had to tell myself over and over that I was not going to suffocate with the mask over my mouth, that it was providing air and I would be fine, just fall asleep. I dozed and was probably in a really light sleep, but I guess it was enough to be having events.

And look at it this way, you are having your first study next year. In the event you need a second study, it is likely that everything after that will be covered whatever percent your insurance covers. Hopefully your deductible will be met and you have the rest of the year to get all the supplies you can before the next year starts and you'll have to pay more out of pocket. Don't do the auto-ordering from your DME. Find out what your replacement schedule is from your insurance and order your supplies as soon as you can. You probably won't NEED half of your supplies so that will carry you into the following year. I mean come on, my DME wants me to change the filter in my machine every two weeks. The machine's manual says 6 months. I don't dust as often as I should, but even with the really cheap filter that my DME sent it lasted around 4 months. I took it out and blew on it and rubbed it a little with my finger to get the tiny bit of dust out. I only changed it because like I said, it was really cheap and when I rubbed it the last time little bits of the filter flaked off. So I think I have enough filters to last me at least 3 years, and I've only been on PAP since mid-April. I have two extra humidifiers and an extra heated hose. The way I see it, you're paying for your insurance, you've met your deductible, get as much in the year that you can for as little as possible. After that, price it out, but don't let your DME auto resupply you because they don't care if your year is up and you don't want to pay what they are going to charge you, they have your CC information and a form that you signed, they will drag their feet for as long as possible hoping to wear you down.

No, I've never been claustrophobic. I appreciate your encouragement to try all the masks and make sure I manage my replacement supplies personally. You are right, I was having a knee-jerk reaction to just not liking the idea of nasal pillows. I would be remiss if I didn't at least try a set. I've surprised myself before by trying things I didn't think I'd like.

And thanks for the grounding. It's my job to seek treatment and respond responsibly to what actually happens rather than obsess about what might (or might not) happen.

Educating myself in preparation is a good thing; but I shouldn't let that exploration become an obsession. My new motto is:

"Learn but live in the moment."

Thank you. I needed that.

_________________I wake up every day and I think, 'I'm breathing! It's a good day.'

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